ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Treatment of pediatric parapneumonic empyemas with pulmonary cavitary lesions
Timuçin Alar1, Cemal Özçelik2, Serdar Onat3, Zerrin Özçelik4, Emin Sırrı Bayar5
1Department of Thoracic Surgery, Medicine Faculty of Çanakkale Onsekiz Mart University, Çanakkale, Turkey
2Department of Thoracic Surgery, Medicine Faculty of Çukurova University, Adana, Turkey
3Department of Thoracic Surgery, Medicine Faculty of Dicle University, Diyarbakır, Turkey
4Department of Pediatric Surgery, Medicine Faculty of Çukurova University, Çanakkale, Turkey
5Department of Thoracic Surgery, Bandırma State Hospital, Balıkesir, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.6225
Background: This study aims to evaluate the treatment approach and timing of surgical intervention in pediatric parapneumonic empyema cases with cavitary lesions.

Methods: Between January 1990 and December 2006, 38 patients (21 boys, 17 girls; mean age 4.1+2 years; range 1 to 15 years) from the pediatric age group treated for parapneumonic empyema with cavitary lung lesions at the Dicle University Faculty of Medicine Department of Thoracic Surgery were retrospectively analyzed. The demographic characteristics, symptom duration, radiological examinations, treatment methods, and time to recovery of cavitary lesions during the hospitalization and follow-up were evaluated.

Results: A total of 13 patients (34%) were given medical treatment, while 25 (66%) underwent surgical treatment. The medical treatment group had a statistically significantly shorter inpatient duration than the surgical treatment group (p=0.010). Analysis of the postoperative inpatient duration revealed that the surgically treated patients stayed statistically significantly shorter in the hospital than the medical treatment group (p<0.001). A bronchopleural fistula (BPF) was found in eight (21%) patients and all were in the surgical treatment group. The mean time to recovery of cavitary lesions during follow-up was 48.7±8 days (range, 22-106 days).

Conclusion: Treatment of parapneumonic pediatric empyema cases with cavitary lesions should include controlling the pleural process with standard empyema treatment, considering pneumonia treatment as an integral part of the disorder, performing surgical treatment if a bronchopleural fistula is present or otherwise waiting patiently for the cavitary lesions to regress and postponing open surgical treatment until the recovery period is completed.

Keywords : Cavitary pulmonary disease; pediatric empyema; pleural empyema
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